MEMBERSHIP APPLICATION
Annual Membership Fee is $50.00
Administrative year covers June 1st to May 31st

Name *

First

Middle

Last

Nickname

Company

Title

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Fax

Email *

College

Organization Affiliations

Do you belong to the American Assocation of Professional Landmen? *

• Yes
• No

Are you a Certified Professional Landman or Registered Land Professional?

• CPL
• RPL

Please choose a term for New Membership or Renewal (Dues $50.00 Per Year) *

• 1 Year - $ 50.00
• 3 Years - $ 150.00
• 5 Years - $ 250.00

New or Renewal Membership: *

• New Membership
• Membership Renewal

Please choose a Payment Method: *

• PayPal (Secure Payment)
• Mail in Payment to P. O. Box 718, Roswell, NM 88202

Total

$ 0.00

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